Cervical Screening: HPV Testing, Pap Tests, and Your Results

A letter or portal message says your cervical screening result was "HPV positive" or "ASC-US." You may feel worried or embarrassed. Please do not be. HPV is very common, and most abnormal results are not cancer. This guide explains how cervical screening works, who should be screened, and what the results usually mean.

Why cervical screening works

Almost all cervical cancers are caused by long-lasting infection with high-risk types of human papillomavirus (HPV). HPV spreads through sexual contact and is extremely common. Most infections clear on their own within 1 to 2 years [3].

When high-risk HPV stays for many years, it can cause abnormal cells on the cervix. These precancer changes can be found and treated before they become cancer. Screening finds them.

The two main tests

• HPV test: checks for high-risk HPV types in cells from the cervix or vagina. Some tests also say whether you have types 16 or 18, which carry the highest risk.
• Pap test (cytology): looks at cervical cells under a microscope for abnormal changes.
• Co-testing: both tests on the same sample.

Both tests can use the same sample, collected with a speculum exam. Some HPV tests can also use a self-collected swab from the vagina [4].

The move to HPV testing

HPV testing finds more precancers than a Pap test alone, and a negative HPV test means very low risk for several years. So many programs now use HPV testing as the main screen and repeat it every 5 years. In Canada, several provinces, including British Columbia and Ontario, have moved to HPV-based screening. British Columbia also offers self-collection kits.

What your clinician checks: who should be screened

US guidance

The US Preventive Services Task Force (USPSTF) 2018 recommendation [1]:

• Under 21: do not screen.
• Ages 21 to 29: Pap test every 3 years.
• Ages 30 to 65: Pap test every 3 years, HPV test alone every 5 years, or co-testing every 5 years.
• Over 65: stop if past screening was adequate and you are not at high risk.
• After hysterectomy with removal of the cervix for a non-cancer reason: stop.

The USPSTF released a draft update in 2024 that favours HPV testing from age 30 and includes self-collection. Check the USPSTF website for its final status.

Canadian guidance

The Canadian Task Force on Preventive Health Care 2013 guideline [2]:

• Under 25: do not routinely screen.
• Ages 25 to 69: screen every 3 years with a Pap test.
• 70 and older: stop if you had 3 negative Pap tests in the past 10 years. If not, continue until you have 3 negative results.

This guideline predates HPV-based screening. The Task Force ended its mandate in March 2026, and provincial programs now set the test and schedule. Programs that use HPV testing usually start at 25 and repeat every 5 years when the result is negative.

The key differences

• Start age: 21 in the US, 25 in Canada.
• Upper age: 65 in the US, about 69 or 70 in Canada.
• Test: both are moving from Pap tests to HPV tests.

Understanding your results

HPV results

• HPV negative: very low risk. Return for routine screening.
• HPV 16 or 18 positive: higher risk. A colposcopy is usually advised [3].
• Other high-risk HPV positive: your sample is often checked with a Pap test. If the Pap is normal, you may be asked to repeat testing in about 1 year. If abnormal, a colposcopy is often advised.

Pap test results

The NCI lists the common Pap results [3]:

• Normal (negative): no abnormal cells.
• ASC-US: unclear cell changes. Often followed with HPV testing or a repeat test.
• LSIL: low-grade changes, usually from HPV, that often clear on their own.
• ASC-H or HSIL: possible or definite high-grade changes. Colposcopy is usually advised.
• AGC or AIS: changes in glandular cells. These need prompt follow-up.

What is a colposcopy?

A colposcopy uses a magnifying lens to look closely at the cervix. The clinician may take a small biopsy. If high-grade precancer is found, a short procedure can remove the abnormal area. Treatment is very effective.

Getting ready for your test

You can make the test more accurate and more comfortable.

• Book for a day when you do not have your period, if you can.
• Avoid vaginal creams, douches, and sex for about 2 days before, unless your clinic says otherwise.
• Tell the clinician if you are pregnant, have had a hysterectomy, or have had abnormal results before.
• Ask for a smaller speculum or a pause at any time if you are uncomfortable.
• Ask if a self-collected swab is an option for you.

Questions to ask your clinician

• Which test was done, HPV, Pap, or both?
• What does my result mean for my risk?
• When is my next test, and why that interval?
• Do I need a colposcopy, and what will happen during it?
• Is self-collection available to me?
• Can I stop screening at my age?

When to get care quickly

Screening is for people without symptoms. See your clinician soon, not at your next routine screen, if you have:

• Bleeding after sex, between periods, or after menopause.
• Unusual vaginal discharge or pelvic pain that does not go away.

Go to the emergency department for heavy vaginal bleeding with dizziness or fainting.

Bottom line

Cervical screening prevents cancer by finding HPV and precancer early. The US screens from 21 to 65, and Canadian national guidance used 25 to 69, with provinces now leading the move to HPV testing. Most positive results are not cancer and often clear on their own. Follow-up, such as a repeat test or colposcopy, is what keeps risk low.

Primary AI can show you the guideline and study sources behind this topic in plain language, so you can bring better questions to your appointment.